Clinical values of CA19-9, CA125 and CEA in malignant obstructive jaundice

Serum CA19-9, CA125 and CEA are glycoproteic tumor markers and they have been used for detecting patients with pancreatobiliary diseases in whom obstructive jaundice is common. This study was designed to investigate whether cholestasis may interfere with the clinical application of these tumor markers or not.

Radioimmunoassay for serum CA19-9, CA125 and carcinoembryonic antigen (CEA) was obtained from 86 patients with hyperbilirubinemia, including 50 patients with malignant jaundice (pancreatic carcinoma 20, biliary tract carcinoma 30) and 36 patients with benign jaundice (choledocholithiasis 33, acute cholangitis 3). Clinical follow-up for the utility of these markers on the patients with obstructive jaundice was conducted.

In patients with malignant jaundice, higher positive rates of CA19-9 (94% vs 56%, p < 0.01), CA125 (52% vs 17%, p < 0.01) and CEA (42% vs 6%, p < 0.01) than in those with benign jaundice were found. In diagnosis of malignant tumors, sensitivity was superior in CA19-9 (94%) than in CA125 (52%) and CEA (42%), but the latter two had higher specificities (83% and 95%). In malignant jaundice, elevated serum bilirubin levels were correlated with CA125 (r = 0.34, p < 0.05) but not with CA19-9 levels. In benign jaundice, serum bilirubin were correlated with CA19-9 (r = 0.58, p < 0.001) and CA125 (r = 0.45, p < 0.01) levels. The correlation between serum bilirubin and CEA levels was not significant in either group. After effective drainage, all markers decreased significantly in patients with benign jaundice but not in those with malignant diseases.

Elevated serum CA19-9, CA125 and CEA levels were observed in both benign and malignant pancreatobiliary diseases with obstructive jaundice. Longitudinal follow-up of these markers and other complementary studies are essential for diagnosis of malignant tumors when cholestasis is present.